41例青年缺血性脑卒中病因、危险因素及影像学特点探析

The etiologies,risk factors and the imaging features of ischemic stroke in young adults:analysis of 41 cases

目的探讨青年缺血性脑卒中的常见病因、危险因素及影像学特点。方法回顾性分析41例18～44岁青年缺血性脑卒中患者病例资料,按TOAST分类探讨各病因、危险因素并分析其影像学特点。结果明确病因的青年缺血性脑卒中患者,病因依次为脑动脉粥样硬化、感染性/非感染性脑血管炎、心源性脑栓塞、小动脉闭塞、血管畸形和颅内血管瘤,常见危险因素包括血脂异常、Lp(a)升高、吸烟、高血压、心脏疾病和糖尿病史,ESR、hsCRP升高对卒中的发生有激发作用。影像学表现的特点与病因类型关系密切,有助于卒中的病因诊断和二级预防。结论青年缺血性脑卒中病因及危险因素多样,脑动脉粥样硬化和脑血管炎较常见,明确病因有赖于完善各项检查。

Objective To study the etiologies, risk factors and imaging features of ischemic stroke in young adults. Methods We analyzed 41 cases of ischemic stroke in young adults aged between 18 to 44 retrospectively, explored the etiology according to the TOAST classification criteria, analyzed the risk factors and imaging features. Results The identified etiologies for young adults with ischemic stroke in decreasing order of frequency were large-artery atherosclerosis, infective/non-infective cerebrovasculitis, cardioembolism, small-artery occlusion, vascular malformation and cerebral aneurysm. The most frequent risk factors of ischemic stroke in young adults included dyslipidemia, elevated level of Lp（a） , cigarette smoking, hypertension, heart diseases and diabetes mellitus. Elevated level of ESR or hypersensitive-CRP was the trigger factor and increased the risk of ischemic stroke. There were strong correlations between the imaging features and the etiologic types of ischemic stroke, which could be useful for the etiologic diagnosis and the second prevention of stoke in young adults. Conelusions There are multiple eitologies and risk factors for ischemic stroke in young adults and large-artery atherosclerosis and cerebrovasculitis are the most common one among them. A thoughtful and thorough examination is required to identify the etiology for the young stroke patient.